MEDICARE: MILANA MADATOVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	30305037	NY

General Provider Information

NPI Number	:	1235367145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILANA MADATOVA

Provider Business Mailing Address
First Line	:	27 JESSICA LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-1967
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 E 14TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3916
Country	:	US
Telephone Number	:	718-375-2100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	06/30/2009

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Directions to “ MILANA MADATOVA ” Practice Location

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